Cardiac imaging in ischemic stroke or transient ischemic attack of undetermined cause: Systematic review & meta-analysis

Gerlinde van der Maten*, Saskia Dijkstra, Matthijs F.L. Meijs, Clemens von Birgelen, Job van der Palen, Heleen M. den Hertog

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Patients with ischemic stroke or transient ischemic attack (TIA) of undetermined cause often undergo cardiac imaging in search of a cardioembolic source. As the choice of the most appropriate imaging approach is controversial and therapeutic implications have changed over time, we aimed to identify in patients with “cryptogenic stroke or TIA” the yield of transthoracic or transesophageal echocardiography (TTE or TEE) and cardiac computed tomography (CT). Methods and results: We performed a systematic review and meta-analysis according to the PRISMA guidelines. Included were studies that assessed consecutive patients with ischemic stroke or TIA of undetermined cause to evaluate the yield of TTE, TEE, or cardiac CT for detecting cardioembolic sources. For each type of cardioembolic source the pooled prevalence was calculated. Only six out of 1458 studies fulfilled the inclusion criteria (1022 patients). One study reported the yield of TTE, four of TEE, and one of both TTE and TEE; no study assessed cardiac CT. Mean patient age ranged from 44.3–71.2 years, 49.2–59.7% were male. TTE detected 43 cardioembolic sources in 316 patients (4 (1.3%) major, 39 (12.3%) minor), and TEE 248 in 937 patients (55 (5.9%) major, 193 (20.6%) minor). The most prevalent major cardioembolic source was left atrial appendage thrombus, yet results were heterogeneous among studies. Conclusions: TTE and TEE infrequently detect major cardioembolic sources that require a change of therapy. Findings should be interpreted with caution due to the limited number of studies. A large-sized prospective clinical trial is warranted to support evidence-based decision-making.

Original languageEnglish
Pages (from-to)211-218
Number of pages8
JournalInternational journal of cardiology
Early online date29 Jun 2021
Publication statusPublished - 15 Sept 2021


  • Cardiac emboli
  • Echocardiography
  • Ischemic stroke
  • Transient ischemic attack
  • UT-Hybrid-D

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